The longer I practice medicine, the more nervous I get about medications, especially when patients are already on other drugs for chronic diseases. I much prefer deprescribing. A recent study on the common antibiotic cotrimoxazole, which is a combination of sulfamethoxazole and trimethoprim, and often referred to by its brand name, Bactrim or Septra, lends […]
Over the weekend, I watched a speech by Dr. Mike Evans about using social media to educate patients and caregivers. Dr Evans is an academic family medicine doctor who also runs a media lab. He makes those famous whiteboard presentations, such as 23 and 1/2 hours, which now has more than 4-million views. His talk […]
If you ever hear your doctor say we are going to do something because there is nothing else to do, be afraid. Be very afraid. First of all, it should be self-evident that if caring and empathy and relief of suffering count as doing something, there is always something to do for patients. A growing problem […]
The election I am going to watch today is in San Francisco. On the ballot there is Proposition E, an initiative to add a 2-cent tax for every once of sugary beverage. Choose Health SF, a group supporting the tax, estimates it would raise $54 million, which would go towards, get this: “funding active recreation […]
There is a lot of talk about rewarding value in US healthcare. Don’t believe any of it. It’s not happening. Not even close. This is a post about the real world–where I practice medicine. In a comment on yesterday’s post, Lisa wondered how I connected the current model of employing doctors and paying them on […]
What follows is a short intro to my latest column on theHeart.org | Medscape Cardiology. —- The title of the piece is Three Concerning Trends in the Electrophysiology Clinic. I worked on the 750-word piece the entire week. It was hard to get the tone just right. This is because the trends do not reflect […]
Maybe you wonder why a cardiologist writes about vaccines and mammography. It is because I have grown intensely interested in the medical decision. As a doctor in a preference-sensitive field, electrophysiology, how do I help patients understand and choose the best path–of which there are many. This seems like a simple task, but with humans, […]
This is a short intro to my latest column over at Trials and Fibrillations on theHeart.org Medscape|Cardiology. —- I am not sure why doctors so often look past the best medicine. It’s right there before our eyes. Yet somehow we get sidetracked by the culture of pills and procedures. Modern-day caregivers fail to master the […]
In July, I wrote a short blog post expressing doubt about the value of statin drugs. Medscape republished it on their website and it went viral–in a medical sort of way. The post has 631 comments. It was Tweeted extensively, page views have been off the charts (for me), and I even received an invitation […]
What follows is my most recent editorial in the Journal of the Kentucky Medical Association. It is reposted with permission. **** One day every month, my wife Staci, a hospice and palliative care physician, goes to see an elderly woman in the nursing home. The routine has gone on for years, which is surprising because […]
I was pleased when the editors of the TheHeart.org reposted my recent essay, Let’s Stop the Unnecessary Treatment of Heart Disease. As of this morning, there are 167 comments. The majority of them were positive, and supportive of lifestyle promotion. Negative comments represented a small minority, but were notable in their vigor, and occasionally reached […]